A recent survey details the discordance between recommendations on aspirin use in older adults and real-world use of the long-time mainstay in risk management.
By
Patrick Campbell
| Published on February 4, 2025
4 min read
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Despite major medical organizations warning against the use of aspirin for primary prevention of heart attack or stroke, 1 in 5 older adults still report daily use of low-dose aspirin.
A survey conducted by the Annenberg Public Policy Center (APPC) of the University of Pennsylvania, results suggest daily use of low-dose aspirin for primary prevention—preventing first-time cardiovascular events—occurred among 22% of respondents aged 60 years or older, with an additional 4% using weekly or multiple times per month. Further highlighting the disparity between real-world practice and medical recommendations, fewer than 10% were aware the risks of use outweighed the benefit based on current data.
Aspirin has been a cornerstone of cardiovascular disease prevention for decades, once considered a simple, cost-effective tool to reduce the risk of heart attacks and strokes. Its role in primary prevention gained momentum after landmark studies in the 1980s, such as the Physicians’ Health Study, which demonstrated aspirin’s ability to significantly lower the risk of heart attacks in healthy men.
Not long after, the first formal guidelines recommending aspirin for primary prevention were issued in the late 1990s and early 2000s, solidifying its place in preventive cardiology. By the mid-2000s, aspirin use peaked, with studies showing that nearly 40% of older adults in the U.S. were taking aspirin regularly, many without a prior history of cardiovascular disease.
For years, aspirin was viewed as a mainstay in prevention efforts, routinely recommended for individuals with risk factors like hypertension, diabetes, or high cholesterol. However, as new evidence emerged about the risks of bleeding outweighing the benefits in certain populations, guidelines evolved.
In 2019, the American College of Cardiology (ACC) and American Heart Association (AHA) updated their recommendations, advising against routine aspirin use for primary prevention in adults over 70 or those at increased bleeding risk. In 2022, three years after the publication of the new AHA guidelines, the U.S. Preventative Services Task Force recommended against starting a new regimen of low-dose aspirin use for the primary prevention of cardiovascular disease for those aged 60 years and older without a history of cardiovascular disease or signs or symptoms of cardiovascular disease.
Despite this well-documented shift in guidance from major medical organizations, many individuals continue to take aspirin for primary prevention, reflecting the enduring legacy of its once widespread endorsement.
The APPC survey is a nationally representative panel of 1771 US adults, with the majority taking in part in the survey since April 2021. The data used in this analysis was recorded from a survey fielded between November 14-24, 2024.
Overall, the survey found 18% of individuals without. A personal history of heart or attack or stroke reported regular aspirin use, with 43% of respondents reporting belief that benefits of daily aspirin outweighed the risk. Investigators highlighted significant differences across age groups, but noted the majority of patients in each age group were knowledgeable of the risks associated with aspirin use.
Among adults aged 18–39, 29% correctly reported the risks outweigh the benefits for primary prevention, which was the highest awareness across age groups. In contrast, only 11% of adults aged 40–59 and 7% of those 60 and older identified the risks correctly.
“Habits backed by conventional wisdom and the past advice of health care providers are hard to break,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center and director of the survey, in a press release. “Knowing whether taking a low-dose aspirin daily is advisable or not for you is vital health information.”
